title: Pulmonary vein isolation using a pace-capture-guided versus an adenosine-guided approach: effect on dormant conduction and long-term freedom from recurrent atrial fibrillation--a prospective study.
abstract: BACKGROUND
  Atrial fibrillation recurrence after pulmonary vein (PV) isolation is associated with PV to left atrium reconduction. We prospectively studied the use of 2 procedural techniques designed to facilitate identification of residual gaps within the index ablation line.
  
  
  RESULTS
  After wide circumferential PV isolation, 40 patients received additional ablation targeted at locations of left atrial capture during high-output pacing (pace-capture group), while 40 patients underwent adenosine testing with targeted ablation at sites of dormant conduction (adenosine group). Patients were followed up at 3, 6, and 12 months. After PV isolation, high-output pace-capture was documented in 39 PVs (25%; 50% of patients) in the pace-capture group. Dormant conduction was unmasked in 34 PVs (22%; 53% of patients) in the adenosine group. A subset of 25 patients in the pace-capture group underwent adenosine testing without targeted ablation of dormant conduction. In these patients, only 10 out of 86 PVs (11.6%; 24% of patients) demonstrated dormant conduction after the elimination of local pace-capture. At a follow-up of 329±124 days, the single procedure off antiarrhythmic drug freedom from recurrent atrial fibrillation was 67.5% in the adenosine group and 65.0% in the pace-capture group (P=0.814). Procedure duration and fluoroscopy time were significantly longer in the pace-capture group (P=0.002 and P<0.001), whereas radiofrequency ablation time was comparable (P=0.192).
  
  
  CONCLUSIONS
  The use of high-output pacing post-PV isolation results in a significant reduction in the incidence of dormant conduction with a comparable long-term freedom from recurrent atrial fibrillation (versus adenosine-guided ablation). The use of these approaches requires evaluation in a long-term prospective randomized study. [corrected].
authors.affiliation: Electrophysiology Service at the Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Pollak
authors.forename: George
authors.initials: G
authors.lastname: Monir
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Marc
authors.initials: M
authors.lastname: Deyell
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: atrial fibrillation; atrial fibrillation arrhythmia; catheter ablation